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Theological Bioethics: An Introduction

This is the first part of a multi-part series on bioethics. These essays were written in place of my term paper for a bioethics class I had with Dr. Allen Verhey at Duke Divinity. I’m hoping for a post a week. Stay tuned. But first, an introduction.

The term “bioethics” was first coined in the 1960’s, but its history is much older, dating back to the ancient Greek philosophers and the eventual adoption of the Hippocratic Oath by physicians. For much of its early history, bioethics has been mostly driven by religion and theology, with the gods or God standing as the final arbiter of a moral ethic. Important to this (relatively) early history is the medical and scientific ethic put forth by Sir Francis Bacon (1561-1626) that medicine and science should seek to eliminate human suffering and alleviate death. For much of recent history since Bacon, this ethic (sometimes called the Baconian Project) has held sway in the medical and scientific communities and, though Bacon had Puritan leanings, set the stage for the future secularization of bioethics.Bioethics has recently arisen as a distinct field of study among ethicists. Part history of science, part philosophy, part sociology, and part science fiction, bioethics is the study of ethics as it relates to medical, biomedical, and biological research practices. It addresses imminent issues such as current requirements for care, just distribution of the fruits of research, the choices to be made at the end of life, and the ethical conduct of research. Bioethics also addresses the ramifications of far-future biological technologies and seeks to direct these to an ethical conclusion consistent with our humanity.

In the 1950’s, there was a move away from a theological basis for bioethics, described as an Enlightenment of sorts, that insisted that all moral principles be expressed in a universally understood lexicon. Theological voices were silenced, or at least moved away from using explicitly theological language. Then, starting in the 1980’s, there was recognition that there was a need for theological voices to re-enter the dialogue, and there was a Reawakening of sorts. This brings us to today and the resurgence of strong theological voices being heard today in the discourse.

In the next months I hope to bring to you a fresh look at theology based bioethics from the perspective of one who is both a scientist and a Christian. I will look at some key ethical issues and review a few case studies within the bioethics debates.

Helpful to my review will be several key concepts in ethics. To start with, I will reference three primary ways of looking at moral dilemmas: teleology, deontology, and aretalogy; the management, political, and identity modes of thought respectively. Teleology has been reduced in modern secular ethics to a concern with the goods and ends of a particular action. It asks, “What good is accomplished?” and is subject to the corollaries “What is good?” and “Whose good is it?” The result of teleological inquiry is that those actions that will bring the most good to the most people will be permissible. For example, genetic therapies are permissible only if they maximize the positive outcomes and are made widely available.

Alternatively, deontology is concerned with rights, laws and duties related ethical decisions in its modern, reduced form. It asks “Whose choice is it?” thereby placing emphasis on one’s agency for choice. Rights under deontology come in two forms: positive and negative. The negative right is that one has a right to something, but not necessarily to all of the means to achieving that something. Positive rights state that other people have a duty to help you exercise your right. For example, the negative right to an abortion allows any woman to seek an abortion, but does not require doctors to perform it. The positive right to an abortion would require that any doctor with the ability to perform an abortion to assist any woman seeking one.

Finally, aretology is attentive to the identity of the moral being faced with an ethical question. Central to an aretological line of questioning is the questioner’s narrative and relationships to communities with which they associate (church, school, neighborhood association, professional association, etc.). Aretology asks “Which choice has integrity with my identity?” For example when faced with the choice to remove a dying loved one from life support, one has to ask “What choice fits my story?”

Of these three, aretology is the most important for a theological perspective in bioethics. The utility and legality of ethical situations has been thoroughly explored and debated by the secular bioethics community and are important for making value judgments (in both senses of the word value). However, theology is based around a narrative, in the case of Christianity provided by the Bible, and a community, the church. Any ethical decision by a professed Christian must conform both to the story and communal relationship of the Christian church. Certainly, one can find goods and laws in the Bible, and the importance of these is not to be discounted, but integrity to identity is perhaps the most useful contribution of Christian theology to the modern bioethics debate.

The Christian narrative I confess is that only God is God and that the highest miracle is the miracle of salvation and resurrection through the life, death, and resurrection of Jesus Christ. We live in a story in which our own salvation and resurrection in the New Kingdom of God has not yet been realized, but which has already been inaugurated by Christ and glimpses of which can be seen in our healing, teaching, and loving acts. This not-yet-but-now narrative demands attention to how we order our lives and health that is consistent with the resurrection that was, is, and is yet to come.

Thus, the Christian story rejects the Baconian project, as it is too easy to hold life and health as idols with in it. Instead, the Christian story declares that life and health are great goods, but not the greatest good. Similarly, death is a great evil, but not the greatest evil, because of the promised resurrection which has broken the spiritual power of death over us. Therefore, when we as Christians seek to preserve life, avoid death and enhance health, we must do so in preparation for and within the New Kingdom realized. We are freed from the duality that is body and soul, but are called to maintain life and health as goods, to oppose the evils of death and suffering, and to live the example set by Christ as embodied persons. How is this simply expressed Christian ethic enacted in the world of science in medicine? How does this ethic place limits on our actions and desires in seeking biomedical solutions to issues of health and life and death?

The following essays are not meant to be a condemnation of theology, bioethics, science or medicine. They all have a part to play in recognizing the human condition and defining human nature. These essays are meant to reconcile Christian theological bioethics, and more broadly Christian theology, with science and medicine in James Gustafson’s “dialogue of participation.” By pointing out how each bears on the other, I hope to reveal the ways in which all are interdependent in discerning the human enterprise.